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Motorcycle INSURANCE QUOTE QUESTIONNAIRE
Sather's Insurance Service requests that you complete the information listed below. Sather's will return a quotation within 24 hours. If you allow up to 30 hours for a quotation, this will allow Sather's to properly process your information and receive more competitive quotes.

All fields are required in order for your quote to be processed.

PRIMARY DRIVER

*ALL FIELDS REQUIRED
Name of Primary Driver:
Address where motorcycle is
being stored at night:
City:
State:
Zip Code:

Phone:

 

 

Primary Driver's
Personal info
*ALL FIELDS REQUIRED
Date of Birth:
ie.12/06/05

Marital Status:

Single Married Divorced

 
Number of Moving Violations in the past 36 months
If none, type "0".
Number of Charged Accidents in the past 36 months
If none, type "0".
Number of Alcohol Violations in the Past 36 Months
If none, type "0".
 

 

Motorcycle information
*ALL FIELDS REQUIRED
Year of the Motorcycle:
Make of the Motorcycle:
ie: Harley Davidson, Honda, etc.
Model of the Vehicle:
ie: FXHL, GSX, GOLDWING, etc.
Number of C.C.'s:
 

 

Liability and Other
*ALL FIELDS REQUIRED
Request Liability Limit:
Your Desired Requested Limit:
(Ex: 25,000/$30,000/$50,000)
/ /
Requested Deductible for Damage
to your Automobile:

Please include uninisured
motorists on my quote:

Yes No

 

 

Do you have a current policy with someone else
Yes No
If Yes:
 
My Current Policy is with:
My Policy will Expire on:
 
Please Send Me My
Quotation via Email:
   
I would like to have Sather's
price this policy every:
 
Email Address of Account Holder

For Quotes involving more than one driver or one motorcycle,
please contact one of our agents at 1-800-4SATHER.